Goal 3: Advance Translational Research

Building Effective Interventions for Heart-Healthy Eating

What translational science approaches are best able to test individual, community, and environmental approaches for increasing adherence to heart-healthy dietary recommendations, such as the Dietary Approaches to Stop Hypertension (DASH) diet? What are the most effective types of interventions (e.g., personal coaching, print material, interactive internet content, faith-based community programs, campaigns) and tools ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

This information will inform intervention, education, and outreach efforts and ultimately result in reduced CVD risk.

Feasibility and challenges of addressing this CQ or CC :

Similar studies have been done in this time frame.

There is strong evidence, based on controlled feeding studies, that DASH-style eating patterns can lower blood pressure and improve blood lipids, and thus reduce risk for CVD. Yet, very few individuals regularly follow DASH.

 

Enabling resource needs.is a challenge in addressing this CQ.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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18 up votes
9 down votes
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Goal 1: Promote Human Health

Evaluation of large-scale regulatory efforts in the US and elsewhere

A number of cities(e.g Berkeley), states and countries (e.g Mexico's SSB tax, Chiles SSB and soon marketing controls and food package front of package label) will go into effect. Rigorous evaluations of the efforts will provide some sense of their potential to effect food purchase and dietary pattern and ultimately cardiometaboiic changes. Serious rigorous independent evaluations are needed to learn if these options--pushed ...more »

Submitted by (@popkin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

We must learn what we can from the natural experiments not only in the US but globally about both the effects of these efforts on food industry behavior as well as household and individual food purchases and dietary patterns and subsequently their effects on obesity and key cardiometabolic outcomes. This requires serious rigorous teams of scholars to utilize a combination of commercial data sets on food purchases, individual diet, body composition measures of obesity and fat composition and biomarkers.

Feasibility and challenges of addressing this CQ or CC :

These efforts are occurring and will be accelerating across many countries in Asia and Latin America. At the same time many cities or states in the US are moving to implement limited sets of key changes. There is a pressing need to learn if these efforts truly will matter and what changes would be needed to enhance their impact, if any. Finding large-scale regulatory ways to reduce improve our diets, prevent/reduce the prevalence of obesity and all the diet and obesity-related NCD's is critical.

Name of idea submitter and other team members who worked on this idea : Barry Popkin

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42 up votes
20 down votes
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Goal 2: Reduce Human Disease

Is heart failure reversible by diet and lifestyle changes?

Once heart failure has developed, can diet and exercise measures work to reverse it?

 

Well-designed clinical trials are needed to answer this question.

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

There is no known therapy that can reverse heart failure. Drug and device treatments may slow progress but not a cure. If diet and lifestyle changes could reverse heart failure, even if just in segments of the heart failure population, it would be a tremendous impact in saving lives and would have a great fiscal impact as well.

Feasibility and challenges of addressing this CQ or CC :

Innovative dietary and lifestyle intervention studies could be done cheaply and efficiently.

There is low impact, mostly anecdotal evidence that heart failure (HF) is reversible through diet and exercise, but no higher level research has investigated this question. It is an accepted notion that healthy diet and exercise can prevent cardiovascular diseases. Obesity, diabetes and coronary artery disease are strong risk factors for HF. Accordingly, a high portion of HF patients has ischemic etiology, is obese and/or diabetic. Diet and lifestyle interventions could beneficially influence these comorbidities and might reverse HF.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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6 net votes
34 up votes
28 down votes
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Goal 2: Reduce Human Disease

Dietary nitrates and the enterosalivary nitrate cycle

Are dietary fruits and vegetables, particularly leafy greens, protective against cardiovascular disease due to their ability to increase bioavailability of nitric oxide?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Understanding the biological rationale behind the benefit of a particular dietary component that promotes CV health will substantiate public health recommendations about diet.

Feasibility and challenges of addressing this CQ or CC :

Our understanding of the nitrate/nitrite cycle and of cardiovascular activity of nitric oxide has advanced rapidly in the past 10-15 years. The time is ripe for linking these advances in the science of nitrates to the consequences of dietary nitrate.

The role of dietary fruits and vegetables in the protection against cardiovascular disease is supported by many studies, especially leafy green vegetables. However, identification of the component of fruits and vegetables affording this protection has been elusive. Recent discoveries about the ability of the body to cycle dietary nitrates to produce bioactive nitric oxide via the enterosalivary cycle and lingual microbiome lends strength to the argument that leafy green vegetables may be protective due to their high nitrate content. This possibility should be examined in both large cohort studies and in clinical series. Would be helpful for the USDA to add nitrates to their standard database of food nutrients. NHLBI needs to partner with NCI to coordinate with ongoing research about the potential nitrosylation of dietary nitrites to carcinogenic n-nitrosamines in the setting of low antioxidant intake.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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52 up votes
35 down votes
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Goal 1: Promote Human Health

Achieving accurate and valid dietary assessment for implementing precsion prevention

Combine objective measures and biomarkers of dietary intake to identify dietary deficiencies/excesses that contribute to risk for cardiometabolic diseases. Technological, statistical and methodological advances in diet assessment are increasingly making it possible to identify the nutrients/phytochemicals/ that contribute to risk factor development in individuals and populations. Interdisciplinary studies are needed to ...more »

Submitted by (@lvanhorn)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

There is no longer any question that diet, food, eating patterns and overall nutritional status influence health and risk of disease. Over the past fifty years the field of nutrition has grown and become increasingly evidence-based as illustrated by the important work of the US Dietary Guidelines Advisory Committees that are convened every five years to review the new and expanding data relevant to public health. Despite tremendous advances, the field remains handicapped by the absence of accurate objective diet assessment methods that could enhance the recognized limitations and flaws in the existing system. Studies that rely on self-reported recall of dietary intake are inherently limited by cognitive ability, memory, honesty and capacity to provide the details needed to accurately portray a persons nutritional intake. Advances in technology that include metabolomics and other omics, refinements in biomarker measurement and statistical advances such as principal component analyses have been helpful, but most existing studies are limited to one or two of these options, using flawed diet assessment methods and very few days of dietary intake that do not do justice to accurate reflection of nutritional status. Comprehensive studies are needed to combine the available methods and develop approaches that can more precisely identify the relevant factors and thus offer opportunities for improvement.

Feasibility and challenges of addressing this CQ or CC :

Successful accomplishment of this challenge will ideally involve Big Data approaches. We are now aware of hundreds of nutrients, micronutrients, phytochemicals and the foods, food groups, eating patterns and environmental factors that all likely contribute to health or risk for disease.

Team science involving nutritionists, biostatisticians, chemists, IT specialists, bioinformatiticians , agricultural specialists, just to name a few will be needed to clearly lay out the key factors and design appropriate approaches to develop the appropriate studies, methodologies and analyses that can address these questions. The time has come!

Name of idea submitter and other team members who worked on this idea : Linda Van Horn, PhD, RD

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4 net votes
7 up votes
3 down votes
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Goal 2: Reduce Human Disease

What is the role of diet and nutrition in treatment, management and prevention of Heart Failure?

Heart Failure (HF) remains a major public health burden. A working group was convened by NHLBI and ODS in June, 2013 to address the role of diet and nutrition in management of HF. A review of existing evidence produced no clear rationale for appropriate dietary interventions. On the contrary, the group developed recommendations for conducting additional research specifically on the role of sodium, fluid, nutrients, and ...more »

Submitted by (@lvanhorn)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

As summarized following the Working Group meeting,compared with the situation for cardiovascular risk factor management, there is little well-founded evidence regarding the efficacy, safety, and clinical impact of dietary modifications for patients with various HF phenotypes. The importance of diet and nutrition to promote health and prevent or control disease is well established. Research on obesity, hypertension and cardiovascular disease have contributed to the development of nutritional guidelines to prevent these disease in the general population but efforts to determine nutritional needs for the patient with HF lack high caliber evidence regarding safety, efficacy, and clinical impact of dietary modifications. The stronger evidence and focus on disease prevention and health promotion with diet modifications like DASH cannot be easily applied or extrapolated for disease management, especially HF, because of critical knowledge gaps and potential harm. Research on HF has more recently identified and differentiated medical treatment and interventions appropriate for HF with or without preserved ejection fractions. This only adds to the questions surrounding diet and nutritional approaches to help reduce and prevent HF readmissions.

Feasibility and challenges of addressing this CQ or CC :

Chronic HF often presents as a multisystem disease with important co-morbidities such as anemia, insulin resistance or diabetes, autonomic dysregulation, and impaired renal function. Intestinal dysfunction with impaired motility and circulation and disturbed intestinal barrier and flora may lead to a chronic inflammatory state and nutrient malabsorption. In advanced cases, catabolic/anabolic imbalance is associated with cardiac cachexia, a difficult to treat condition which itself carries a poor prognosis. Furthermore, psychosocial symptoms associated with HF, including depression and impaired cognition, can contribute to poor self-care and lack of adherence to recommended dietary, physical activity, and medication regimens. Nutritional status concerns for patients with HF increase with disease severity. Salt restriction is now controversial and clinicians give little attention to diet as a potential intervention to improve outcomes. Proposed recommendations:

1.Determine the correct sodium threshold; ranges of sodium and fluid intake, and the safety for sub-groups including HFPEF, HFREF, and cardiorenal syndrome. 2.Generate new knowledge which identifies therapeutic targets and understand the role of the gut microbiome on gastrointestinal malabsorption, inflammation, and protein balance in HF.

3.Apply innovative study designs to reduce evidence gaps 4.Develop technologies to facilitate nutrition research and address weight and multiple risk factors should be addressed.

Name of idea submitter and other team members who worked on this idea : Linda Van Horn, PhD, RD

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Goal 3: Advance Translational Research

Ranking Impact of Dietary Changes on Reducing cardiovascular disease Risk

Of the components of DASH diet, which dietary changes have the greatest impact on reducing cardiovascular disease risk factors?

How can we rank the relative health effects of individual dietary changes such as reducing sodium, increasing fiber, reducing saturated/trans fats, etc. to identify where to target interventions for promoting initial dietary changes?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

This will inform intervention, education, and outreach efforts.

Feasibility and challenges of addressing this CQ or CC :

Similar studies have been conducted in that time frame.

Strong evidence shows that following a DASH-style dietary pattern can lower blood pressure and improve blood lipids, and thus reduce risk for cardiovascular disease. The DASH dietary pattern is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts and low in sweets, sugar-sweetened beverages, and red meats. In terms of nutrients, the DASH dietary pattern is low in saturated fat, total fat, and cholesterol and rich in potassium, magnesium, and calcium, as well as protein and fiber.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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11 net votes
21 up votes
10 down votes
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Goal 2: Reduce Human Disease

Diet and prevention of cardiovascular events

In the US, what kind of diet(s) is/are best for preventing hard cardiovascular events?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Provide an evidence base for public policy on diet.

Feasibility and challenges of addressing this CQ or CC :

The Spaniards have shown that this kind of trial is possible. We have tools and interest in place for pragmatic trials.

 

The PREDIMED trial (done in Spain) randomized ~7000 adults and found that a diet supplemented with olive oil or nuts reduced cardiovascular events compared to a "low-fat" diet. However, in Spain the Mediterranean diet is arguably the norm.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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8 net votes
20 up votes
12 down votes
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Goal 1: Promote Human Health

Reduce burden of vascular disease

How can we reduce the burden of vascular disease by promoting healthy lifestyle including diet, exercise, and smoking cessation?

Submitted by (@societyforvascularsurgery)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

­Conduct community level and scale studies in higher risk populations, identify effective tools to achieve healthy lifestyle and prevent or retard the progression of vascular disease. Determine which interventions work.

Name of idea submitter and other team members who worked on this idea : Society for Vascular Surgery

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Goal 3: Advance Translational Research

Move beyond the use of self-report for dietary intake quantification

There is a need to move beyond the use of self-report for dietary intake quantification towards funding the development of new technology and broader use of objective measures. There is no question that the effects of diet on health, quality of life, and longevity are of great interest to many and plausibly of great importance. Because of that, tremendous research resources have been provided to study this topic. Given ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Virtually all authors and investigators in this area recognize that such measurements are limited in their validity; the common mantra is that while limited, these methods nevertheless have sufficient validity to merit being used in scientific investigations. In contrast, a growing group of investigators, ourselves included, think that this common mantra is not reasonable. Virtually all authors and investigators in this area recognize that such measurements are limited in their validity; the common mantra is that while limited, these methods nevertheless have sufficient validity to merit being used in scientific investigations. In contrast, a growing group of investigators, ourselves included, think that this common mantra is not reasonable. Instead we believe that the evidence clearly shows that with at least respect to self-reported energy intake, the measurements are so inaccurate that they do not warrant being used as a basis for scientific investigations and conclusions, even when no better measurement is available. Therefore, at least in investigations involving energy intake, we believe that self-report methods should be abandoned for purposes of drawing scientific conclusions about energy intake, and that funds made available for human dietary investigations be directed toward development of new, objective methods and technologies that can replace self-report methods.

Feasibility and challenges of addressing this CQ or CC :

We believe that the scientific community would benefit from development of methods of measuring dietary intake that do not rely upon self-report. We are not recommending that more investment go into refining self-report methods but rather that replacement methods be sought. Some investigators are interested in devices such as smartphone photography as a way of enhancing self-report. It is our intuition that such methods will only be modest enhancements and will be subject to very substantial biases, since they rely on subject cooperation. Instead, we believe that that methods based on principles of physics, engineering, and chemistry (and generally less prone to human filtering/interference) are likely to be more useful in the long run. Investing in such methods could take at least two forms. First, funders could invest in the development of new technologies and techniques. Second, funders could invest in ways that alter the economic conditions for the use of existing techniques, notably doubly-labelled water (DLW). It is remarkable how much the cost of genotyping has decreased in the last several decades, driven by market incentives and a market initially catalyzed by NIH investment. This is not the case with DLW, which has stayed at a fairly constant price for 30 years. We suggest that it may be possible for the NIH to create a market incentive for reductions in price by initially catalyzing a large demand through an infusion of funding for research using DLW.

Name of idea submitter and other team members who worked on this idea : David B. Allison, Ph.D.; Kevin Fontaine, Ph.D.; Kathryn A. Kaiser, Ph.D.; Andrew W. Brown, Ph.D.; Edward C. Archer, Ph.D.

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2 up votes
1 down votes
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Goal 2: Reduce Human Disease

What causes the structural abnormalities that cause sleep apnea, and how can they be prevented?

It is estimated that up to 28% of the population suffer from sleep apnea, which impairs functioning and reduces quality of life, while increasing risk of accidents and a variety of cardiovascular, metabolic, and neuropsychiatric diseases. A large portion of sleep apnea cases are caused by abnormal oro-nasal-maxillo-mandibular features that result in crowding of the upper airway, making it vulnerable to collapsing or ...more »

Submitted by (@bmdixon)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Obstructive sleep apnea (OSA) is a common condition, which causes chronic fatigue and daytime sleepiness, as well as cognitive impairments affecting learning, concentration, and memory. Over the long term, it increases many health risks, including accidents, cardiovascular disease, and depression. OSA is characterized by partial, or complete, blockage of the airway during sleep, so that breathing repeatedly pauses or airflow is limited, causing repeated arousals from sleep. It is usually secondary to a narrow, or collapsible, airway due to either 1) obesity or overweight, or 2) abnormal morphology of the mandible or maxilla bones, which crowds facial structures, such as the tongue and nose, narrowing the pharynx. The causes of obesity are already being well studied, but there is relatively little research on the etiology of the structural abnormalities involved in OSA. Abnormalities of facial structure are widespread in the population causing, not only OSA, but also orthodontic problems that require many to get braces or have wisdom teeth extracted, and widespread temporomandibular joint (TMJ) problems. However, multiple studies have documented that these abnormalities are almost completely absent from populations living a preindustrial, agrarian or forager, lifestyle, making them a “disease of civilization”. In particular, the abnormalities are associated with consumption of a modern diet of processed foods during prenatal, infant, and early childhood development.

Feasibility and challenges of addressing this CQ or CC :

Current evidence implicates three factors in the development of these structural abnormalities: prenatal maternal nutrition (especially vitamin K2 status), breastfeeding vs. bottle-feeding, and frequency of consumption of tough foods after weaning (which provides exercise to the jaw). We need to form a large cohort and study orthodontic development prospectively from fetal development through mid-childhood, with data on diet, feeding practices, and physiological measures of nutrient status. Measurement methods are available using existing technologies to collect the necessary data on each of these measures. Determining the causes responsible for these structural abnormalities will enable further research to demonstrate effective methods of preventing them. Given that many patients with OSA are rendered so miserable by it that they undergo maxillomandibular advancement surgery to correct it, an expensive procedure with a lengthy recovery period, prevention would be a far better solution. This research will move us a big step closer to a future without sleep apnea and its formidable collection of negative effects on health and functioning.

Name of idea submitter and other team members who worked on this idea : Bonnie Dixon

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44 up votes
38 down votes
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Goal 3: Advance Translational Research

Need to Determine the Basis for Difference in Response to Weight Management Approaches

Why does the response to weight loss regimen in terms of weight loss and its sustainability, and improvement in health outcomes vary considerably?

Submitted by (@mturner)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Past research focused on using variations of diet and exercise has revealed important information about the health benefits of weight loss. The limitations of such approaches in producing biologically meaningful and sustained weight loss for the majority have also been recognized. Even within a study population, compliance to weight loss regimen, weight loss and its sustainability, and improvement in health outcomes vary considerably. Research is needed to identify the basis for this variation, which may lead to enhanced outcome and applicability of such approaches.

Feasibility and challenges of addressing this CQ or CC :

Identifying factors that enhance weight management response may lead to translational studies that yield more effective results. A strong support of promising clinical translational research may promote a conducive environment for developing more practical applications.

Name of idea submitter and other team members who worked on this idea : The Obesity Society

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8 net votes
14 up votes
6 down votes
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